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BBVA Foundation International Study on Attitudes to Stem Cell Research

Unlike most scientific and technological advances, which tend to take their place silently in society, biotechnology often finds itself the center of public debate and regulatory attention, due partly to the moral issues posed by many of its applications.

In this second BBVA Foundation international study on “Attitudes to Biotechnology” (the first was in 2003), the sample has been enlarged from nine to twelve European countries (Austria, Czech Republic, Germany, Denmark, Spain, France, Ireland, Italy, Netherlands, Poland, United Kingdom and Sweden), with the addition of countries from other continents; namely the United States, Japan and Israel. The selection of countries was informed by both their demographical weight and their variability from the standpoint of religious beliefs and cultural traditions.

Information was gathered through 1,500 face-to-face interviews in each country with subjects aged 18 and over (around 22,500 interviewees in all) conducted between April 2007 and February 2008. The design and analysis of the survey were the work of the Department of Social Studies and Public Opinion of the BBVA Foundation.

The present study focuses on attitudes towards one biotechnology application: research with embryos for the purpose of obtaining stem cells. In particular, it analyzes how far public opinion is informed about stem cells, expectations and reservations regarding research with embryonic stem cells and differences in support for such research depending on the origin of the embryos used. Attention also goes to the attitudes held on the creation of hybrid embryos for stem cell research.

Public understanding of the nature of stem cells

The data show that the percentage of the population that admit having heard or read anything about this kind of cell was notably uneven across the survey countries: over 70% had heard or read about stem cells in Sweden and Denmark (86%), and also the United Kingdom, Netherlands and United States (between 70% and 75%); and over 55% in Italy, France, Ireland, Spain, the Czech Republic and Germany: while awareness of stem cells was less than 45% in Poland, Austria, Israel and Japan.

As well as information about stem cells, the survey enquired about how far citizens understood the properties of such cells and the procedures used for obtaining them. The results point to a moderate understanding of stem cell properties: surpassing 50% in seven of the fifteen countries, between 40% and 50% in another four and below this threshold in the four remaining (Austria, Poland, Japan and Israel).

In contrast, people had a poor understanding about how stem cells are extracted and the consequences for the embryo, with percentages no higher than 30% in the United States, between 15% and 20% in a further six countries and lower still in the remainder.

Views about research with stem cells

In most societies there is a broad consensus around the usefulness of research with few-day-old human embryos in order to obtain stem cells. The mean agreement score with the idea that such research is very useful stood higher than the midpoint (5 on a scale from 0 to 10) in all countries except Austria, and was upwards of 6 points in nine of the fifteen countries, with Denmark and Sweden out in front.

But this overall perception of usefulness does not rule out feelings of risk or moral dilemmas. Hence the data show considerable reservations about the risks entailed by researching with human embryos that are a few days old for the purpose of obtaining stem cells. There is general disagreement with the idea that this application poses no serious risks, with mean agreement scores below the midpoint (5) in eleven of the fifteen countries. The citizens perceiving least risk are the Danish and the Dutch, with Austrians, Americans and Japanese lined up at the other extreme.

The moral or immoral nature of the application meets with divided opinions among survey countries. The majority view in Austria, Germany, Poland, Japan, Israel and United States is that this kind of research is immoral (mean agreement score above the midpoint on the scale), while those most strongly disagreeing with this supposed immorality are the citizens of Denmark, Spain, the United Kingdom and Italy (mean agreement score below the midpoint). Finally, opinions tend to cluster round the midpoint in the remainder of countries.

Possible medical benefits

Debate and regulations regarding research with embryonic stem cells try to weigh up the medical benefits that may be obtained in future (the end pursued) against the moral reservations felt about this kind of research (the means utilized).

When the possible medical benefits deriving from stem cell research are opposed in abstract terms to the rights of the embryo, opinions are divided both between and within countries:

In Spain, the Czech Republic, Sweden, Denmark, France and the Netherlands, the balance leans to a greater or lesser extent towards the side of medical benefits. Hence the majority agree with the statement that “the medical benefits for many human beings that can perhaps be obtained in the future thanks to research with embryos that are a few days old are much more important than the embryos' rights”.

In Austria, Ireland, Germany, Poland, the United States, Japan and Israel, the balance inclines more or less (depending on the country) towards the rights of embryos: that is, a majority dissent from the idea that “the medical benefits for many human beings that can perhaps be obtained in the future thanks to research with embryos that are a few days old are much more important than the embryos' rights”.

Finally, the balance is more centered (mean value of 5) in the United Kingdom and Italy.

When the potential medical benefits are spelled out as treatments for what are seen as serious diseases (Parkinson's, Alzheimer's or diabetes), a majority in all countries declare themselves in favor of such research. The mean agreement with the assertion that “research with stem cells from embryos that are a few days old should be supported as a means of finding effective treatments for diseases such as Parkinson's, Alzheimer's or diabetes as soon as possible” was above the midpoint in every country with the exception of Austria, and exceeded 6 points in nine cases, with Spanish and Czech citizens agreeing most strongly.

Besides moral objections, this kind of research meets with other reservations to do with ideas of what is natural or unnatural and concern about interfering with or altering the balance of nature. Citizens in most of the survey countries tended to agree that “research with human embryos that are a few days old is an unacceptable interference into the natural processes of life”, with agreement being firmest in Germany, Austria, Poland and Israel.

There is also widespread concern that this kind of research may lead to other more dubious uses. The idea that “allowing research with embryos that are a few days old in order to obtain stem cells for use in medicine will open the door to other morally reprehensible uses” meets with considerable approval even in the countries favorably disposed to this application. The consensus round this view is especially marked in France, Germany and Japan.

At the same time, research using embryonic stem cells touches on the moral or ethical framework of each individual, and in this sense moral criteria of religious inspiration are a key explanatory vector. In a context of plural opinions, the data show that the dominant view of the moral condition of the few-day-old human embryo is that it is close or identical to that of a human being. The strictly biological view finds widest support in Denmark and Sweden, where opinions are more equally distributed between those believing it makes no sense to talk about a moral condition of the embryo and those seeing it as close or identical to a human being. This view of the embryo as close or identical to a human is most frequently expressed in countries such as Austria, Germany and the United States.

In Spain, opinions are quite sharply divided: 27% state that it makes no sense to talk about the moral condition of an embryo that is a few days old, while 25% take the intermediate position and another 35% see its moral condition as close or identical to that of a human being.

Acceptance of the use of embryos depending on their origin

Public debate and regulatory attention concerning research with stem cells has recently crystallized around two concrete scenarios: the use of spare embryos left over from fertility treatments and the use of embryos created specifically for biomedical research purposes.

Citizens in most survey countries make differing judgments on these two scenarios, with acceptance of the use of spare embryos in all cases greater than that of embryos created for research. In the case of spare embryos, mean scores were in the approval zone in all countries except Austria (4.4) and Japan (4.6), and stood higher than 6 points in Denmark, Sweden, the Czech Republic, the Netherlands and Spain. In the case of embryos created for research, scores tended to range from 4 to 5 points, with support only at all emphatic in the Czech Republic (6.2). The citizens of Spain, Italy, the United Kingdom and Poland expressed marginal approval (just scraping in above 5 points on the scale) while remaining countries were all in the rejection zone.

Creation of hybrid embryos

Faced with a shortage of human embryos for use in advancing stem cell research, British scientists have sought official permission to create hybrid embryos. In September 2007, the UK agency regulating embryo research and fertility treatments (Human Fertilization and Embryology Authority) approved the creation of hybrid embryos for the purpose of obtaining stem cells for biomedical research. The technique in question involves the implanting of the nucleus of an adult human cell into the egg of an animal from which the nucleus has been previously extracted.

The BBVA Foundation survey also questioned citizens about their attitudes to such advances. The creation of hybrid embryos causes divided reactions both between and within countries. The baseline scenario meets with attitudes of rejection (below 5 on an acceptance scale from 0 to 10) in most of the countries studied. Only in the Czech Republic, Spain, Italy, Israel and Denmark does the mean score approach the midpoint on the scale. The citizens of Poland, France, Austria and Germany are the most critical of this application.

Predominant in most countries is the fear that the technique could get out of control and lend itself to dangerous uses. This feeling appears to run deepest in Poland, France, Austria and Israel. A rather different reaction emerges in Denmark, the Netherlands and Sweden, where rejection of the creation of hybrids appears to have less to do with fear, and possibly more to do with perceptions that it is interfering with nature.

In general, the use of spare embryos left over from fertility treatments meets with a high level of acceptance (most notably in Denmark and Sweden with mean scores of 6.8 and 6.7 respectively on an acceptance scale from 0 to 10). Conversely, opinions are divided over the creation of embryos for biomedical research, with ethical reservations being voiced in most countries (lowest levels of acceptance in Germany and Austria at 4.0 and 4.2 respectively).

Spaniards come out clearly in favor of the use of spare embryos (mean score of 6.1 on an acceptance scale from 0 to 10) and, to a lesser extent, the use of embryos created specifically for research (5.3).

The creation of hybrid embryos (of animal-human origin) for obtaining stem cells is rejected in most of the countries analyzed.

Javier Fernández | alfa
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